Phase II, double-blind, randomized study of salvage radiation therapy (SRT) plus enzalutamide or placebo for high-risk PSA-recurrent prostate cancer after radical prostatectomy: The SALV-ENZA Trial.

Authors

Phuoc Tran

Phuoc T. Tran

University of Maryland School of Medicine, Baltimore, MD

Phuoc T. Tran , Kathryn Lowe , Hao Wang , Hua-Ling Tsai , Daniel Y. Song , Arthur Hung , Jason W.D. Hearn , Tamara L. Lotan , Channing Judith Paller , Mark Christopher Markowski , Samuel R. Denmeade , Michael Anthony Carducci , Mario A. Eisenberger , Matthew Orton , Curtiland Deville , Stanley L. Liauw , Elisabeth I. Heath , Neil B Desai , Tomasz M. Beer , Emmanuel S. Antonarakis

Organizations

University of Maryland School of Medicine, Baltimore, MD, Johns Hopkins, Baltimore, MD, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, Oregon Health & Science University Department of Radiation Oncology, Portland, OR, University of Michigan, Ann Arbor, MI, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, Johns Hopkins University School of Medicine, Baltimore, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, Indiana University, Lafayette, IN, University of Chicago Pritzker School of Medicine, Chicago, IL, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, UT Southwestern Medical Center, Dallas, TX, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, University of Minnesota Masonic Cancer Center, Minneapolis, MN

Research Funding

Pharmaceutical/Biotech Company

Background: We sought to investigate whether enzalutamide (ENZA) treatment, without androgen deprivation therapy, increases freedom-from-PSA-progression (FFPP) when combined with salvage radiation therapy (SRT) in men with recurrent prostate cancer post-radical prostatectomy (RP). Methods: Men with biochemically recurrent prostate cancer after RP were enrolled into a randomized, double-blind, phase II, placebo-controlled, multicenter study of SRT + placebo vs SRT + ENZA. The randomization (1:1) was stratified by center, surgical margin status (R0 vs R1), PSA prior to salvage treatment (PSA ≥0.5 vs < 0.5 ng/mL), and pathologic Gleason sum (7 vs 8-10) using a minimization algorithm. Following randomization, patients received either placebo or ENZA 160 mg PO once daily for 6 months. Following 2 months of study drug therapy, external beam radiotherapy to 66.6-70.2 Gy was administered to the prostate bed (no pelvic nodes). The primary endpoint was FFPP. The trial design was powered for a HR 0.44 FFPP benefit with intended enrollment of 96 subjects and was closed as planned to enrollment on March 2020 short of that goal. Secondary endpoints were time to local recurrence (LR) within the radiation field, metastasis‐free survival (MFS), and safety as determined by frequency and severity of adverse events (AEs). Results: A total of 86 patients were randomized with a median follow-up of 34 (range 0-52) months. The median pre-SRT PSA was 0.3 (range 0.06-4.6) ng/mL, 56/86 (65%) had extra-prostatic disease (pT3), 39/86 (45%) had Gleason Grade Group 4 or higher and 43/96 (50%) had positive surgical margins. Trial arms were well balanced. FFPP was significantly improved with ENZA vs placebo, for example 2-year FFPP was 87.1% vs 68.1%, respectively, and overall with a HR 0.40 [95% confidence interval (CI), 0.17-0.92, p-value = 0.026]. Subgroup analyses demonstrate differential benefit (p-value of interaction = 0.031) of ENZA in men with pT3 (HR 0.19, 95%CI 0.05-0.67) vs pT2 disease (HR 1.29, 95%CI 0.34-4.81). There were insufficient secondary endpoint events for analysis. The most common adverse events were grade 1-2 fatigue (13% ENZA vs 9%) and urinary frequency (6 % ENZA vs 8%). Conclusions: SRT plus ENZA monotherapy for men with PSA recurrent high-risk prostate cancer following RP is safe and delays PSA progression relative to SRT alone. The impact of ENZA on distant metastasis or survival is unknown at this time. Additional molecular biomarker analyses are being pursued. Clinical trial information: NCT02203695.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer–Local-Regional Disease

Clinical Trial Registration Number

NCT02203695

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 5012)

DOI

10.1200/JCO.2022.40.16_suppl.5012

Abstract #

5012

Poster Bd #

196

Abstract Disclosures